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MAMA Mia! Are mHealth programmes living up to the hype?

13th June 2014

Mobile communication technology is becoming a more popular tool in maternal health. Three years on since Hillary Clinton launched the MAMA programme and as Canada prepares to host the Maternal, Newborn and Child Health Summit, we look at the possibilities and potential pitfalls of this tool.

Easy to use on the move, cheap and technology-focused, mobile communication has quickly become a popular aspect of development projects.

For maternal health, this can include sending information and advice to pregnant woman at different stages of their pregnancy, monitoring the levels of stock in health centres and enabling cash payments. The use of mobile technology in health is also known as mHealth.

“Mobile communication technology provides a new opportunity to reach people that were not reachable before, in ways that they couldn’t be engaged before,” says Patricia Mechael is the Executive Director of the mHealth Alliance.

The Aponjon initiative was set up under this partnership by Bangladesh-based social enterprise Dnet. It runs a service for new and expecting mothers and their families where information is delivered twice a week to mothers and once a week to family members. This is done either through SMS or short ‘mini-skit’ voice messages, with a mixture of ‘direct’ and ‘drama’ messages using actors in roles such a pregnant woman and doctor.

Rizwana Rashid Auni, CEO of Dnet and Director of the Aponjon programme, says the project now has over 500,000 subscribers. “It would have not been possible for us to go door to door to all those people delivering service for 89 weeks,” she explains. “Using mobile phone technology makes the project cost effective, reachable within a very short period of time.”

Although there is a lot of excitement around mHealth for development, some in the sector have concerns about the challenges involved in doing this effectively.

Institute of Development Studies Research Fellow, Inka Barnett, has worked on several development projects which involve mobile phone technology for nutrition. She feels that there is not yet enough critical literature on issues around mobile technology. “Even when projects fail this is not really highlighted very strongly,” she says.

Barnett says that the use of mobile technology can often be a 'top-down' idea, coming from an international NGO’s headquarters or national government. “I think mobile phone technology is often seen as a quick fix without analysing what the challenges on the ground are and where the mobile phone might really help,” she explains.

James BonTempo is the Director of ICT & Innovation at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, the lead partner in the Knowledge for Health (K4Health) Project. “Because this technology, unlike other technologies that have come before it, has been so widely adopted it’s almost as if people have been seduced by it in some way,” he says. “You have this one tool and so every challenge suddenly starts to look like one that can be solved with it… If it's not an information or communication challenge then this isn’t the tool for you.”

When looking at maternal health, gender issues around power and inclusion are especially pertinent. Women can have less access to or control over the household mobile phone or budget.

“Often women are 20 per cent less likely to own or have access to a mobile phone than their male counterparts,” says Mechael. “There’s this really interesting fear in some ways of what is happening with technology and women’s access to technology and yet a desire to really empower women through technology. It’s really important to understand where some of these dynamics can come into play.”

The sustainability of mHealth projects is another concern, as highlighted by Anita Gurumurthy and Nandini Chami in BRIDGE’s 2014 publication, Gender equality in the information society: “Donor funding has been useful for establishing pilot projects. However, the integration of these initiatives into public health care systems does require public investment and a systematic revamp of institutional health care delivery.”

Project sustainability is also an important matter for Barnett who also highlights cost, staff turnover and technological capacity as issues. “Often it’s seen that the technical support is just necessary in the very beginning of the project to make sure that everything runs smoothly,” she explains.

As many mHealth projects deal with data, issues such as privacy are important to note. Barnett describes a situation she witnessed while working on a surveillance project: “The small NGO gave the access codes to the surveillance database and they had access to everything including photos of the children, the mothers all their details including where they lived. It’s very sensitive data.

“I think it would be very easy for this data to be used for targeted marketing campaigns.”

Aponjon eventually plan to sustain themselves through their user fee; 80 per cent of users pay a two taka (approximately 2.5 cents) fee and 20 per cent get it free. They also receive corporate sponsorship.

Advertisements are another tool which it is hoped will contribute to funding the project long term after their main funding ends. “Wherever there is a voice format there is the option of giving advertisements for relevant products,” says Auni.

Despite the potential pitfalls, BonTempo says that mHealth remains a powerful approach: “We have a lot of information and communication challenges or bottlenecks within health, and within development more broadly, and here’s a tool that will allow us to potentially address them.

“We just have to be really careful about how we’re applying the tool and make sure were applying it to issues to which it’s appropriate.”

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